Pericarditis Flashcards
What is pericarditis?
Inflammation of the pericardium (membranous sac enclosing heart). Inflamed visceral and parietal layer rub against one another resulting in pain.
*Remember, pericardium is avascular but it does have innervation
State some potential causes of pericarditis- highlight most common
- Idiopathic
- Viral infection e.g. Coxsackie, echovirus, EBV, CMV, adenovirus
- Bacteria e.g. TB
- Autoimmune disease e.g. SLE, sarcoidosis
- Acute MI/Dressler’s syndrome
- Drugs e.g. hydralazine, isoniazid, procainamide, penicillin
- Uraemia
- Trauma, surgery etc..
*
Whats the commonest cause of pericarditis in developing countries?
TB
State the symptoms of pericarditis
- Chest pain
- Sharp
- Retrosternal or left sided
- Worse on leaning back, lying flat, lying on left side, swallowing and/or inspiration
- Better on leaning forwards
- May radiate to left arm/axilla
- Viral prodrome
- Low grade pyrexia
- Malaise
State what you might find on examination of someone with pericarditis?
- Pericardial friction rub heard best over left sternal edge during expiration
- Low grade fever
- Tachycardia
State what investigations you might do for a pt with suspected pericarditis, include:
- Bedside
- Bloods
- Imaging
*For each, justify why
Bedside
- ECG: look for typical features of pericarditis & rule out other causes
Blood tests
- FBC: WCC may be raised
- CRP: may be raised
- Troponin: may be raised
- U&Es: uraemia can be a cause
Imaging
- CXR: may see cardiomegaly (due to pericardial effsuion) on CXR
- ECHO: may reeal pericardial effusion
Describe the ECG changes seen in pericarditis
What is the most specific ECG change in acute pericarditis?
ECG changes:
- Widespread saddle shaped/concave ST elevation
- PR segment depression
PR depression is the MOST SPECIFIC ECG change
Discuss the management of perdicarditis
- NSAIDs or aspirin with gastric protection for 1-2 weeks
- Add colchicine as an adjunct to prevent recurrence for 3 months. NOTE: post-MI pericarditis should be managed with aspirin & colchicine. If give NSAIDs may interfere with healing of myocardium
- Corticosteroids: only be given in connective tissue disease, uraemia or immune mediated pericarditis or if NSAID and colchicine therapy contraindicated or ineffective
State some potential complications of pericarditis- highlight common
- Pericardial effusion
- Cardiac tamponade
- Constrictive pericarditis
Explain the difference between acute post MI pericarditis and Dressler’s syndrome
- Acute post MI: occurs days following MI
- Dressler’s syndrome: occurs months following MI due to immune response
What is constrictive pericarditis?
Progressive thickening, fibrosis and calcification of pericardium which limits the filling of the cardiac chambers.
What % of pts with acute pericarditis may develop constrictive pericarditis?
Around 9%
What is the main cause of constrictive pericarditis in world?
State some other causes
- TB (NOTE: TB not common cause in UK)
Other causes include:
- Cardiac surgery resulting in pericardial truma
- Mediastinal irridation
- Unknown (often the case in the UK)
Describe the typical presentation of constrictive pericarditis
- Presents with features of right sided heart failure
- Raised JVP, Kussmaul sign
- Oedema
- Hepato-splenomegaly
- Ascites
- Dyspnoea and fatigue on exertion due to low cardiac output (as decreased return to left side of heart)
What is Kussmaul sign?
Paradoxical rise in JVP with inspiration
